Is this Advanced Life Support?

[Genie]

Hello! I want to know if I'm being unfair as to what I should have expected from paramedics who came out to my house. I'm hoping you can help me by replying as to what should have been done, or what you would have done!

I called our city 9-1-1 requesting an ambulance for my 67 year old husband who was experiencing severe abdominal pains throughout the morning. It was 1:30 p.m. when we decided something serious was happening to him. He could no longer get up and when he even tried to turn over, he was breathing very heavily.

When I called 9-1-1 I gave a basic background of my husband's health the last 7 months. First he had undergone a colon resection in December. In February he started chemo and radiation for mediastinal cancer, finishing in the middle of May. He was just starting to eat well and gain weight and strength when in the middle of July, the day I called, he got the lower right-sided abdominal pain.

My reading says our paramedics on average, take 8-1/2 minutes to arrive. The dispatcher said it would be about 20 minutes and it took 25. We are within city limits, within two blocks of two major intersecting highways. That isn't my complaint though.

The paramedics came into my house and while I showed one the medicines my husband was taking, the other took my husband's blood pressure and asked him if he was throwing up, which he wasn't. We were told they wouldn't be able to bring the stretcher into our bedroom (we live in a one-floor ranch-style house). They told him to move to the other side of the bed and they would help him walk out, down the hall, to the livingroom. I ran to hold the door open so the one paramedic could come in with the stretcher, but he told me he couldn't get it past the 90 degree turn in the sidewalk outside our door.

I went outside, wanting to lift the thing up myself, turned around and saw my 120 pound husband, in his underwear, painfully coming down the two steps from the door, unassisted. (He had lost 45 pounds because of his cancer treatments.) He was tall enough to get his butt up to the edge of the stretcher, but because of the pain, couldn't lay back. The paramedic made no offer to help! I finally reached round the paramedic to put a hand on his back as he flopped back.

The neighbors were running outside to ask if we needed help. They did have some consideration, murmuring something about giving my husband some privacy. By the time I got the neighbors away, my husband was in the ambulance and thank goodness, they were giving him oxygen and had an I.V. in. The I.V. is easy part since he already has a Groshong catheter.

I am thankful for him being taken to a good hospital. It didn't take them long to get his pain under control and diagnose a ruptured appendix. It's now six weeks later and he is finally getting back to where he was before this all happened – trying to gain weight and strength before undergoing another round of chemo. It was a fantastic surgeon who succeeded with a laproscopy and was able to clean him out well.

I tell all my relatives, friends and neighbors what to expect when they make that call to 9-1-1. He's only 120 pounds so why couldn't they lift him out? He was in horrible pain so how could them make him walk? All they did in our house was check his blood pressure. I now wish we had just gone in our own car. There is a very good chance, due to his cancers that this sort of thing could happen again and we do intend to take a car –- I'm sure I can do better than the paramedics did getting him out of here!

One more thing. Our billing lists the service in the house and the transport to the hospital as both being Advanced Life Support

 

[KEVD18]

it was billed as als because an als crew was used and they performed at least one als procedure(iv).

he shouldnt have been made to walk. if they couldnt get the stretcher in, they should have used a stair chair.

this sounds like a fairly normal call. some bad decisions by the patient/family(waiting half a day to call an ambulance) and some bad decisions by the ems crew(walking the pt instead of carrying). should the crew be disciplined, absolutely. but does that mean you should never call an ambulance again? HELL NO!!!

true, their care wasnt textbook perfect. its was seriously deficient. but the next time he needs medical attention, it might be something the medics can treat onscene/enroute and save his life in doing so. you cant provide those treatments and procedures. failing to call the ambulance could very well cost someone their life next time.

if you feel that strongly about it, initiate proceeding to have that crew punished but dont shun the whole ems system on account of one bad crew.

 

[Genie]

Sorry -- I didn't intend to shun the whole EMS system -- just our city I suppose! I know we would do it over again, but next time I need to know what to expect. I would like to file a complaint with our city and will after I know whether I have any right to complain. I want to complain and try to "fix it" since I have many family and friends that I don't want to experience this!

Please don't blame us for waiting too long. It wasn't a half day, more like 4 hours. I need to explain that this is a man who had already endured lots of abdominal pain from his colon surgery, constipation from CT scans, constipation from morphine (taken with eating because his esophagus had radiation burns), etc. Days before he had to take six bottles of barium for a scan and he figured that's what was causing him trouble.

 

[KEVD18]

i apoligize. i misread your post. i read 1:30 as 10:30. ive seen that type of thing a thousand times. agian, sorry for my mistake.

yes, you absolutely have the right to complain and you should do so as soon as possible. this isnt the sort of thing you want to let go for a while.

i hate to throw my collegues under the bus, but that just not right.

 

[traumateam1]

I agree here with KEVD18. I too hate to put my colleagues under the bus, but that behavior was completely un called for. While there isn't a whole lot you can do prehospital setting for stomach pain, they should have never made him walk. Like KEVD18 said, there is something called a stair chair, a chair with wheels and handles that they could have used. Also they could have covered up your husband a little more than they did.
Like KEVD18 said, complain as soon as you can. We are here to help people, not make them walk with severe abdominal pain to a stretcher while in his underwear.

On a more lighter note: It's good to hear that your husband it doing well. and the reason you had to wait so long (if that's not normal) is there could of been a higher than average call volume going on. If you do have an emergency call 9-11, don't take a personal vehicle. Remember, you can always call 9-11 back if someone's condition gets worse, or you are worried and they will upgrade your call.
Take care, and again glad to hear he is doing well.

 

[triemal04]

Was that an ALS call? Yes.
Should you have been billed for it being an ALS call? Yes.

Beyond that...I, and everyone else here was not there. Thus we don't know what actually happened (not saying that you aren't being accurate, but you aren't passing along everything that happened, and what was seen by those who responded may have differed from what you saw for various reasons...as well, you weren't privy to all the care your husband recieved prehospital it seems, and without knowing everything that happened and the system you live in, they may have done everything possible...albiet maybe not in the nicest way).

It's extremely easy to second guess people, but without all the information...not always the best thing to do.

Threads like this should also always pop a warning flag into people's minds.

 

[KEVD18]

Was that an ALS call? Yes.
Should you have been billed for it being an ALS call? Yes.

Beyond that...I, and everyone else here was not there. Thus we don't know what actually happened (not saying that you aren't being accurate, but you aren't passing along everything that happened, and what was seen by those who responded may have differed from what you saw for various reasons...as well, you weren't privy to all the care your husband received prehospital it seems, and without knowing everything that happened and the system you live in, they may have done everything possible...albeit maybe not in the nicest way).

It's extremely easy to second guess people, but without all the information...not always the best thing to do.

Threads like this should also always pop a warning flag into people's minds.

the only problem with that is that, at least as far as my protocols are concerned, patients are never[/i] allowed to walk under their own power. they, by protocol, may stand and pivot, but are not supposed to be allowed to take even a single step, regardless of chief complaint.

that isnt to say i havent let patient ambulated. thats not the case. but i have never asked or forced a patient to walk. if they are adamant about it and their condition allows it, i will let them walk a reasonable distance. but its their choice and at my discretion. these medics forced a patient to walk an extended distance when the patient was clearly in no condition to do so. i agree that theres is two sides to every story and we cant burn those medics at the stake just on the wife's story. but there is no excuse for that action(actually inaction).

 

[triemal04]

the only problem with that is that, at least as far as my protocols are concerned, patients are never[/i] allowed to walk under their own power. they, by protocol, may stand and pivot, but are not supposed to be allowed to take even a single step, regardless of chief complaint.

that isnt to say i havent let patient ambulated. thats not the case. but i have never asked or forced a patient to walk. if they are adamant about it and their condition allows it, i will let them walk a reasonable distance. but its their choice and at my discretion. these medics forced a patient to walk an extended distance when the patient was clearly in no condition to do so. i agree that theres is two sides to every story and we cant burn those medics at the stake just on the wife's story. but there is no excuse for that action(actually inaction).

Ah, but you're helping to prove my point.
1) Do you know what system these medic's work in? I don't. If it's like my system and many others, they have every right to tell someone to walk to the gurney. Or ask, as the case may be.
2) Are you sure this patient wasn't in any condition to walk? Again, all there is to go on is what the wife is saying (not saying that's she exagerating, just that we don't have all the facts). He very well may have been...and he very well may not have been.
3) What was the extended distance? If it's your average 1 story ranch house from the bedroom to the front door is probably about than 30 feet. (yes, that definetly can be considered extended in some situations)

I'm not saying it was right or wrong, just that it's hard to accurately judge this sort of thing in this type of setting.

 

[KEVD18]

I went outside, wanting to lift the thing up myself, turned around and saw my 120 pound husband, in his underwear, painfully coming down the two steps from the door, unassisted. (He had lost 45 pounds because of his cancer treatments.) He was tall enough to get his butt up to the edge of the stretcher, but because of the pain, couldn't lay back.

so i realize that we're still dealing with only one side of the story, but some of the statements made by the op are faily well inarguable.

 

[triemal04]

so i realize that we're still dealing with only one side of the story, but some of the statements made by the op are faily well inarguable.

Sure. But she also said earlier that he was unable to turn over, which would indicate that he was able to lay flat. And that she wishes she had taken him herself, which again indicates that he was capable of walking.

Again, not sayin right or wrong, just that with only one side in this situation...

 

[KEVD18]

Sure. But she also said earlier that he was unable to turn over, which would indicate that he was able to lay flat. And that she wishes she had taken him herself, which again indicates that he was capable of walking.

Again, not sayin right or wrong, just that with only one side in this situation...

i disagree. he desire to tranport by pov indicates a desire not to deal with ems and/or the bill, not the patients ability or inability to ambulate.

 

[daedalus]

Original poster, the crew took 20 minutes to arrive based on the information you gave to the dispatcher. She probably has a protocol to dispatch Code Two (no lights/no sirens) to all abdominal pain calls. The paramedics should have been more helpful assisting your husband to the gurney. I would file a complaint. Unfortunately, they will be able to bill you at the advanced level because the medic placed an IV.

 

[ffemt8978]

I agree with triemal...none of us were there, so we're only getting one side of the story. We don't know if the patient insisted on walking rather than being carried, we don't know what his vitals were, there's just too much we don't know.

To the OP: A complaint may or may not be warranted, but I would suggest that you, at a minimum, do the following. Call the ambulance company and ask to speak to the supervisor/manager. Get the name of their medical director, and request that this call be sent in for a QA/QC review by their medical director. Then contact that person, and explain your concerns to them. Request to be kept in the loop on this one.

 

[bstone]

Echoing the sentiments here that this crew should have absolutely not made the patient walk. Only when a patient *demands* to walk do I even let them take a few steps. Otherwise I try to keep them off their feet and as comfortable as possible. If the historian is correct then this crew was just being lazy. His level of pain and the area of pain makes it clear that walking is and was a bad idea. If I was their medical director (and I will be one day) I would call them into my office and have them read for me the protocols which say no patient shall walk to the ambulance- especially not one in intractable pain.

 

[Genie]

I wrote, "He could no longer get up and when he even tried to turn over, he was breathing very heavily."

I've tried to be as accurate as possible. No exaggerating has been done because I want good accurate answers. I can get more precise if you like. It's 52 feet from where he got out of bed to the front door. Then he had to step down once unto the front stoop, cross it, go down two steps to the walkway and walked another 15 feet to where they left the stretcher.

I say I should have taken him myself to the hospital – correct! That's because since he had walked that far, he might as well have walked another 15 feet to get into the hatchback of our car!

I know my husband and his pain tolerance. He's amazingly tough. Before I called the ambulance, he rolled out of the bed, crawled into the bathroom, tried to stand so he could use the toilet, and fell into the wall. I helped him back and I was extremely worried about his heavy breathing. Then I had to find a jug and help him urinate into it! Before the paramedics came he asked if I would change his briefs. That was a chore for me since he couldn't raise his butt up! So, I don't know how he got out of the house except because of his determination.

My husband was up and walking within 8 hours of having colon re-sectioning, and his appendectomy. Every week for two months, I was taking him into the hospital to be re-hydrated. His whole system has been "out of whack because of the chemo". Sometimes he could walk in, other times, we put him in a hospital wheelchair. The oncologist would usually tell him he was in serious condition, ask him what his pain level was and he would usually say "3" when I knew it was well over 5! Sorry – I could go on and on. Fact is, he did a feat most healthy people couldn't do and I guess he's really called a survivor.

My neighbors witnessed him coming out of the house on his own.

One more thing – this is Denver, Colorado. I called our 911 for an ambulance. I've been billed by Denver Health & Hospital.

 

[Genie]

Another thing -- this isn't to get out of paying the bill. I already made my payment on it!

 

[EMTDON970]

Ive always said "anything can go BLS"

 

[KEVD18]

Ive always said "anything can go BLS"

spoken with the utmost ignorance possible.

well, let me correct myself. anything can go bls, if you want a large percentage of the patients to die or experience significantly increased after effect or defecits when they could have otherwise been spared.

a cardiac arrest has pretty dismal chances overall, but they are better with the earliest als possible.
for the services that utilize prehospital thrombolytics, they are drastically decreasing lasting effects from strokes.

i could go on all night....

im not one of the people that thinks basics are worthless(and those people do exist, even here). but we have to know our place. we cant handle everything. if we could, there would be no medics. there are als calls and bls calls.

 

[mycrofft]

That was an extermely talented surgeon taking on a ruptured appy via lap scope!

Most immediately convert from scope to open procedure (they have both instrument sets on hand just in case) if they find a ruptured anything; can't visualize, clean and close friable tissues via scope like you can manually. In fact, darn near 100% go to "open".

 

[bstone]

Ive always said "anything can go BLS"

Everything can be ALSed. Not everything should be BLSed.

That's my motto.